Common Learning Challenges in

Sensory Processing Disorder

Brock Eide M.D. M.A. and Fernette Eide M.D.
Neurolearning.com
Facebook.com/SensoryProcessing

This presentation will be posted on Slideshare.net/drseide

Flickr.com/mrhayata
 Ways to Think About
Sensory Processing Disorder

Dr. Jean Ayres defined the clinical syndrome of Sensory

Integration Dysfunction functionally: as an impairment in the
ability to organize sensation for use.

Dr. Lucy Jane Miller: “Sensory Processing Disorder exists when

sensory signals don’t get organized into appropriate responses
and a child’s daily routines and activities are disrupted as a
result.”

Both descriptions emphasize information processing in the

current moment.
We can also view SPD from the
Perspective of Learning.

What kinds of learning and cognitive issues

do we see in children with SPD?
What is Learning?
We can think of learning as: Information that
has been encoded in memory in a form that
can be used.
What Kinds Of Memory Do We Have?

Memory

Long-Term Memory: Information Working Memory: Information you

you can use later. can use now. Mental Desk Space,
or keyboard memory. (Also
considered part of Attention)
 What Kinds Of Information Does
Long-Term Memory Retain?

Declarative Memory: Facts about Procedural Memory: How to do things.

the world. Rules and Procedures, Rote Facts, Things
that become automatic through practice so
you can do them without conscious effort.
 Most Basic Academic Skills
are Procedural
• Most language skills are rule-based, including: discriminating
word-sounds; correctly articulating and pronouncing words;
segmenting words into sounds; phonics (decoding and spelling);
s; grammar and syntax; style and pragmatics.
• Many other academic skills are also rule-based, like: rote (or
automatic) memory (e.g., math facts, dates, titles, terms, or
place names); procedures like long division, carrying over,
borrowing, or dealing with fractions in math; sequences, like
the alphabet, days of the week, months of the year, etc.; writing
conventions like punctuation and capitalization; and motor rules
for forming letters the same way every time when writing by
hand, and spacing evenly between words.
• Classroom schedules, rules, and procedures/organization
 The Link Between
SPD and Procedural Learning:
Same List of Cognitive and Learning Challenges

• Development of Automatic Skills;

• Mastery of Procedures (versus simple facts);
• Rote Memory;
• Working Memory Overload and Attention Challenges;
• Understanding of time, space, quantity, sequence;
• Language Retrieval, organization, prosody, pragmatics;
• Social Fluency (versus comprehension);
 Neurologically, What Links
SPD and Procedural Learning?
Answer: Cerebellar Dysfunction
Senses
Motor
Spatial
Interoceptive (Organs)
Limbic / Emotional
Language
Automaticity

When the cerebellum’s working hard, you don’t have to...

Cerebellar Cognitive Affective Disorder:

“Dysmetria of Thought”
Dr. Jeremy Schmamman, Harvard
 Risk Factors for
for Cerebellar Dysfunction
and SPD essentially the Same
• Preterm birth
• Birth injury
• Down Syndrome, Fetal Alcohol Syndrome
• Deprivation, Child Abuse
• ADHD: the most consistent brain abnormality
• Autism / Aspergers: the most brain consistent abnormality...
• Dyslexia: the most commonly identified brain abnormality
• Developmental Motor Coordination Disorder
• Pediatric Bipolar

The Cerebellum is Particularly Vulnerable to Hypoxia / Ischemia

and is the Most Commonly Affected Area in a Wide Variety of
Conditions Associated with Learning Challenges
 Cognitive/Learning Issues Besides Basic Skills:
1. Attention and Working Memory

• Failure to automatize functions leads to the need for conscious

compensation or oversight.
• When too many tasks require conscious attention, overloading
• of working memory is the inevitable result.
 Sustaining Attention Is Also Harder for
Children With Cerebellar Dysfunction and
Procedural Learning Challenges

• Children with procedural learning difficulties must focus more intently

to perform the same tasks as other children, and this is tiring.
• Think of the difference in attention required to drive the same stretch
of twisty mountain road on a clear day versus a rainy night—and the
difference in resulting stress and fatigue.
 Other Attention Issues with Cerebellar
Dysfunction/Procedural Learning
Problems/SPD

• Selective attention/distractibility (Poor automatic

filtering)
• Difficulty with task switching (set-shifting), dividing
attention, and transitions.
• Difficulty following complex instructions
• Difficulty with “oversight” or executive functions due to
working memory overload
• Poor appreciation and understanding of time/time
management.
 2. Social Interactions

• Learning and using social and self-help rules.

• Most social interactive skills are rule-based.
• Real-time fluency/praxis versus comprehension.
• Auditory processing (telling word sounds apart, hearing in
background noise, sound sensitivity)
• Speech articulation
• Prosody/tone and style (“pedantic” or “mechanical”)
• Bright children often misdiagnosed with autism spectrum
disorders due to unusual style, prosody, or pragmatics, but
generally language comprehension is flexible and fluid
 Take Home Points about
Procedural Learning in SPD
• “How” or “praxis” skills: Things that become automatic through
practice, like rules, procedures, rote facts
• Most Basic Academic Skills are procedural in nature
• Square root rule: take square root longer of number of repetitions to
master
• Affects implicit learning (observation and imitation) more than
explicit (detailed instruction)
• Poor automaticity requires conscious compensation and working
memory overload
• Often show up on WISC as slow processing speed, decreased
comprehension score.
• Alternative learning strategies based on explicit learning and
declarative (factual) memory mnemonics.
Common Academic Labels Given to
Children with Procedural Learning
Challenges

• Dysgraphia
• Dyslexia
• Dyscalculia
• Dyspraxia
• ADHD
• Autism Spectrum
 Sensory Processing & Learning

Visual Auditory Cerebellar / Proprioceptive

Sensory-Motor
Sensory Input

Attention

Output
Pattern Processing
Memory & Learning
 SPD in the Classroom

Reading Math

Writing
 SPD and Reading

Visual – skipped words and lines, misreading

Auditory – mispronounced words, trouble sounding out,
discrimination / phonics mistakes, poor word retrieval
Cerebellar – Impaired reading automaticity

SPD kids may have unrecognized Dyslexia

http://flickr.com/Old Shoe Woman

Visual Demands of Reading

Scholarpedia
 Visual Functions and Reading

Smooth eye movements for reading

Eye saccades or jumps to switch between lines
Focus adjustment near and far
Visual recognition of letters and whole words

Flickr.com/Josh Liba
 Auditory Processing & Reading

Distinguishing similar sounds – „hod‟ for „hot‟, „brush‟ for „blush‟

Quick speech, Sounds within Words
Mishear, Mispronounce, Misspell, Misfiled - „Mushy Speech‟
Misfiled Words Harder to Retrieve

Flickr.com/JKoenig
Interventions for Reading
Multisensory learning
See, hear, air write, say
Auditory discrimination
Auditory memory
Vision and visual memory
Imagery
Teachers, parents, tutors, SLPs,
audiologists, dev optometrists
reading specialists, computers
 SPD and Writing
Automaticity of letter writing
Sensory feedback
Motor planning and execution
Visual and kinesthetic memory
Word retrieval and organization

Flickr.com/pyhooya
 Emotional Toll of Dysgraphia

“His teacher would let him take his work home,

but even after 3 hours, there was no way he could finish…”

Depression
Severe Behaviors
School Withdrawal
Suicidal
Flickr.com/nao.k
Examples of Dysgraphia in Students with SPD
Dysgraphia and SPD
 Impaired Motor Automaticity

Control Cerebellar SPD

Degeneration
(Critchley)

“Draw several squares on top of each other”

May Avoid fingers
Handwriting and Working Memory Overload

Sentence Copy Better than Free Writing

Interventions for Writing

ACCOMMODATE !
Dictation, Typing, Assistive Technology
THERAPY
Fine motor / Upper Girdle Strengthening
Kinesthetic Strategies – Air Writing / Imagery / Verbal
Automaticity Practice – over-learning
LANGUAGE
Template prompts, imitation, writing tutor
Expressive language work – SLP
Assistive software
Flickr.com/cowtools
 Assistive Technology
Word Prediction Software
Report Writers- CoWriter 6
Spelling Prediction
Speech to Text - Dragon Dictate
Text to Speech Software and Browsers
Ginger: Context-Sensitive Grammar
Kindle, iPad, iPhone, iPod, etc.
Intel Reader, Kurzweil
Training and Support for Assistive Tech

More Resources:
DyslexicAdvantage.com

Flickr.com/neuro74
 SPD and Math

Impaired Sense of Number and Quantity

Number Sense Related to Spatial Perception
Finger Agnosia Often Seen with Dyscalculia
Rote Math Facts, Procedural Memory

Normal Intelligence
Counting and Quantity
Sequence and Multiple Steps
Money, Clocks, Time
Math Facts
Students with SPD Often Struggle with Math

Visual Crowding
Impaired Number Writing Automaticity
Working Memory Overload
Impaired Sense of Number and Sequence
 You do not have to be a great calculating wiz
To be a great mathematician or scientist

Math Problem Solving May Be Quite Strong in Dyscalculics

Wikipedia
 Interventions for Math

Kinesthetic Strategies to Number, Quantity

Episodic / Personal Memory for Math Facts
Dysgraphia, Working Memory ,Vision
Accommodations
Math Reasoning ≠ Arithmetic

Flickr.com/Nexus6
 Sensory
Contributions
To Attention

Visual Overload Tunes Out Poor Posture

Visual Mistakes ‘Visual Learner’ Bodily Distractions
Poor eye contact Trouble with Fidgety, Hyperactive
Lazy eye Instructions Poor Hands-On
Worksheet Errors Learners

Lazy eye, birth, dyslexia Preemie, dyslexia, ADHD Birth, preemie, ADHD, dyslexia
This is hard.
Visual Crowding
This is hard.
Visual Crowding
 This is easier.
More whitespace.
 Auditory Attention in the Classroom

Fan, Projector

Students Talking

Distracting Noise

Teacher Speaking

HearingReview.com
 Reduce Visual, Auditory, and Sensory Distractions
Visual Focus, Convergence, Pursuits, Jumps
Auditory Background, Discrimination, Closure
Proprioceptive: Muscle Tone, Spatial Map
Multi-Disciplinary / Referrals
Sequential Multisensory Teaching
Software, neurofeedback

Flickr.com/Noel Zia Lee

Divided Attention

Less Listening When Seeing

http://www.indiana.edu/~cnilab/multiorder.pdf
Improving Divided Attention
Incremental Challenge
Mixed Sensory-Sensory and Sensory-Motor
Seeing-Hearing, Seeing-Moving, Moving-Rote
Home / Normal Kid Activities + Therapy

http://flickr.com/silkegb
 Sensory Learning Survey
Sensory Processing Disorder and Learning
© Eide Neurolearning Clinic 2010

Visual Auditory Proprioceptive / Cerebellar

Attention Visual overload Tunes out with listening Fidgets / sensory seeking
Careless mistakes Missed instructions Flops, poor tone
Distracted by visual details Distracted by sounds Trouble multi-tasking

Memory Problems learning letters, spelling Problems remembering what's Poor procedural memory
mistakes been heard

Trouble with graphs and other Mispronounced words, Word

visual learning substitutions

Reading Skipped words Phonics and rhyme problems Poor reading fluency

Lose place Wild guesses with words

Eyes close to page Avoids reading
Misreads questions
Writing / Speech Large messy handwriting, eyes Phonetic errors in writing and Irregularly formed letters
close to page speech - dropped letters and (impaired automaticity), overload
sounds errors

Spelling mistakes Very poor spelling Visual monitoring of writing

Reversals Trouble retrieving words Reversals

 Sensory Learning Survey
Sensory Processing Disorder and Learning
© Eide Neurolearning Clinic 2010

Visual Auditory Proprioceptive / Cerebellar

Math Problems with crowded Mistakes counting fingers, poor

worksheets approximation

Skipped problems Unable to do multi-stepped

problems

Speech / Socialization Interrupts conversation Poor back-and-forth conversation Poor back-and-forth conversation

Problems hearing in background Awkward speech – self-editing

noise (fluency)
Mispronounced words

Problems learning a foreign

language

Word finding problems

Play / Socialization Retreat from crowded Retreat from crowded Retreat from crowded

Misses visual signals in sports Trouble assemblies, gym, echoing Unexpected falls, leaning on
rooms children in line

Impaired depth perception Can't hear in PE or music Bad at sports – multitasking,

timing
 Join Us on Facebook
Facebook/SensoryProcessing
Neurolearning.com
DyslexicAdvantage.com
Sensory DVDs
Amazon.com
The Dyslexic Advantage is coming Fall 2011

Flickr.com/Inoc